CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 44 43.750000 1618.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 33 80.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 15 36.000000 1332.0000 37.0000
Subtotal (Total Children Is Unduplicated) 44 160.000000 2950.7500 18.4422
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
Subtotal (Total Children Is Unduplicated) 13 33.500000 2337.0000 69.7612
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EI Services,Class #03
INTR-T1013-INTERPRETER 4 8.500000 425.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4 5.000000 50.0000 10.0000
TRAV-TRAVS-Travel by mile 25 1240.000000 551.9100 0.4451
Subtotal (Total Children Is Unduplicated) 28 1253.500000 1026.9100 0.8192
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Total 1447.000000 6314.6600 4.3640
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Number of Children (Unduplicated) With at Least One Service 44
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Center 02
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 44 636.500000 1945.1800 1952.1800
0 0.000000 0.0000 0.0000
Other 222 810.500000 4369.4800 0.0000
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Total 266 1447.000000 6314.6600 1952.1800